Healthcare Provider Details

I. General information

NPI: 1124056197
Provider Name (Legal Business Name): DENNIS R HOLMES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 S. GRAND AVE SUITE 400
LOS ANGELES CA
90015-5324
US

IV. Provider business mailing address

5670 WILSHIRE BLVD SUITE 1740
LOS ANGELES CA
90036
US

V. Phone/Fax

Practice location:
  • Phone: 213-742-5784
  • Fax: 213-742-6055
Mailing address:
  • Phone: 714-522-2001
  • Fax: 714-522-7503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA68940
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: